GM-CSF secreted by murine adenocarcinoma cells modulates tumor progression and immune activity.

During tumor development, growth factors may act in autocrine manner stimulating cell proliferation, or in paracrine manner affecting the microenvironment of the tumor and modulating the immune system. Murine mammary adenocarcinoma M3 tumor bearers develop lung metastases and leukocytosis during its evolution. Previously we described that M3 conditioned media enhanced metastasis incidence, when it was inoculated in tumor-operated mice. In the present study we determine that spleen cells from M3 tumor operated mice treated with M3 conditioned media, were able to transfer the capacity to enhance metastasis to other tumor operated mice. Spleen cells have immune suppressor activity that could be reversed by cyclophosfamide treatment. M3 tumor cells secrete GM-CSF, which is able to promote in vitro proliferation of M3 cells as well as spleen cells. This proliferation could be abrogated by the addition of anti-GM-CSF. We report that the GM-CSF secreted by M3 tumor cells had stimulatory activity on M3 tumor cell and lymphocyte proliferation.

Immune reactivity during the growth of a murine lung adenocarcinoma: evaluation of paraneoplastic syndrome development.

The purpose of this study was to investigate if specific immune responses were present in mice bearing a lung adenocarcinoma that presents paraneoplastic syndromes during tumor evolution. Leukocytosis, mainly due to polymorphonuclear leukocytes, was found from day 15 of tumor growth. Delayed type hypersensitivity response and increased interleukin-6 (IL-6) serum levels were observed along tumor growth. Concomitant immunity, specific rejection of a second inoculum and in vitro specific cytotoxicity occurred at 20 days of implant. In advanced stages of tumor evolution impaired cytotoxicity, accompanied by a great increase of IL-6 in serum, were observed. Role of polymorphonuclear leukocytes and IL-6 overproduction as responsible for immune dysregulation and paraneoplastic syndromes are discussed.

New murine cell line derived from a spontaneous lung tumor induces paraneoplastic syndromes.

LP07 is a new cell line derived from P07 lung tumor, spontaneously arisen in a BALB/c mouse. LP07 is composed of heterogeneous epithelioid polyhedric cells that proliferate at a slow rate, have low plating efficiency and are unable to grow in soft agar. Only some LP07 cells expressed cytokeratins while most of them were positive for vimentin. Ultrastructure studies showed that LP07 cells established rudimentary intercellular unions, formed glandular-like conducts and presented conspicuous secretory granules, suggesting an epithelial-glandular origin, with neuroendocrine components. Upon injection LP07 cells formed poorly differentiated non-invasive adenocarcinomas, and tumor bearing mice developed leukocytosis, hypercalcemia and cachexia. This tumor cell line constitutes a useful tool to study lung tumor biology and paraneoplastic syndromes.

Spontaneous murine lung adenocarcinoma (P07): A new experimental model to study paraneoplastic syndromes of lung cancer.

We report the histological and biological behavior characteristics of a lung tumor (P07) that arose spontaneously in a Balb/c mouse. P07 is a moderately to poorly differentiated adenocarcinoma that secretes granulocyte-macrophage colony stimulating factor (GM-CSF) in culture supernatants. This tumor presents some paraneoplastic syndromes, such as leukocytosis, hypercalcemia and cachexia. taken together with the peripheral blood leukocyte (PBL) counts and serum calcium levels during s.c. tumor growth and after surgery, this study suggests that P07 may be a useful experimental model to study the biology of lung cancer and paraneoplastic syndromes.

The diagnosis of sinusitis in infants and children: x-ray, computed tomography, and magnetic resonance imaging. Diagnostic imaging of pediatric sinusitis.

Plain film radiographic examination, the historical standard, is rapidly being supplanted by computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of sinusitis. In particular, many endoscopic surgeons consider CT to be a mandatory part of the preoperative evaluation. MRI is useful for cases complicated by orbital or intracranial extension. However, because of considerations of cost, the need for sedation, and for CT radiation exposure, conventional x-ray films will continue to play an important role in the diagnosis and management of medically treated sinus disease. Incidental sinus abnormalities in children without apparent symptoms are usually the result of resolving, uncomplicated upper respiratory tract infection. Opacification, moderate-to-severe mucosal thickening, or air fluid levels in patients with persistent symptoms indicate sinusitis. Sinus imaging in children, whatever the modality, is demanding both in obtaining technically adequate studies and interpreting findings. Poor-quality examinations usually overestimate the presence and severity of disease. Ideally, children should be referred to centers with expertise in pediatric ear, nose, and throat imaging.

Double-lumen central venous catheter for percutaneous ureteral perfusion studies.

A commercially available double-lumen central venous catheter that can be inserted over a 0.018-inch guide wire was used for ureteral perfusion studies in three infants. Complications or difficulties were not encountered in any patients. This technique allows simultaneous monitoring of perfusion and intrarenal pressure and requires only a single puncture of the renal pelvis with a 21-gauge needle.

Outpatient performance of invasive radiologic procedures in pediatric patients.

A retrospective review was done of the outcomes of 102 invasive radiologic procedures--including myelography, angiography and needle aspiration biopsy--performed on an outpatient basis in 94 pediatric patients. Four children had complications requiring visits to their physicians, but no patients required hospitalization after the procedure. With appropriate patient selection, invasive studies performed on an outpatient basis in infants, children, and adolescents are safe.

Is ultrasound screening for urinary tract infection "cost effective"?

We prospectively followed 110 patients for 1 year who underwent initial imaging evaluation of the upper urinary tract for infection, monitoring both clinical efficacy and cost. Eighty-seven of the patients had ultrasound studies and 23 had excretory urograms. In our experience, ultrasound screening did not increase the utilization of other upper urinary tract imaging procedures although patient costs were increased solely because of the greater charge for ultrasound relative to excretory urography at our institution.

Prevalence of incidental paranasal sinuses opacification in pediatric patients: a CT study.

A prospective evaluation of the paranasal sinuses was performed on a consecutive series of 137 pediatric patients referred for cranial CT. Approximately one-half of the patients less than 13 years of age had some degree of maxillary or ethmoid sinus opacification. The prevalence and severity of opacification was approximately the same for the maxillary and ethmoid sinuses. Sphenoid sinus abnormality was less common (16% of patients) and was usually minimal or mild. No incidental frontal sinus abnormalities were observed. This study confirms previous reports, based on plain film radiography, of the prevalence of incidental maxillary sinus opacification in children. However, contrary to some prior studies, we did not find a relatively higher rate of opacification in children less than 1 year of age. This may be due to overdiagnosis of maxillary sinus opacification on plain films, in small children. The diagnosis of sinusitis in childhood must take into account not only the radiographic findings but clinical signs and symptoms. Correlation is needed to avoid overdiagnosis in patients referred for sinus radiography for nonspecific indications or who have incidental opacification noted on radiographic or CT studies of the skull and brain.

Posttransplant renal artery stenosis: angiographic study in 32 children.

Renal artery stenosis was identified in 32 children who either developed or had an exacerbation of hypertension after renal transplantation. One child developed renal artery stenosis in two sequential transplants. Renal artery stenosis occurred only in those patients who received transplants from cadavers. In 14 of the 15 patients with end-to-end renal artery anastomoses, the stenosis was at the anastomosis. In 14 of the 18 patients with end-to-side anastomoses, the stenosis was distal to the anastomosis.

Two unusual duplication anomalies of the urinary tract: use of percutaneous urography.

We performed suprapubic percutaneous urography in two patients to diagnose unusual duplication anomalies of the urinary tract, since preoperative diagnosis was unclear after routine noninvasive studies. In both patients standard suprapubic puncture technique was employed. The procedure was used to confirm the diagnosis of duplication of the bladder in one case and to establish the site of origin of a ureterocele in the other. The technique employed in suprapubic cystography may be extended to the diagnosis of unusual cystic abnormalities in the pelvis that may be of urinary tract origin.

Ultrasound and the diagnosis of renal and ureteral calculi.

We retrospectively compared ultrasound examination with plain film radiography of the abdomen (KUB) in the diagnosis of renal and ureteral calculi in 13 patients. Overall, ultrasound was more sensitive than KUB (84% versus 54%) in detecting calculi. However, KUB was superior for the diagnosis of ureteral stones. No calculi were detected by intravenous urography that were not first seen on either ultrasound or KUB. Our experience suggests that the combination of ultrasound and KUB is less invasive and more sensitive than intravenous urography for the diagnosis of calculi in patients with symptoms and signs suggestive of stone disease or who are at high risk for stone formation.

Mesenchymal hamartomas of the liver in childhood: sonographic and CT findings.

Mesenchymal hamartomas of the liver usually present within the first 2 years of life. Abdominal enlargement and respiratory distress are the most common presenting features. Pathologically, the lesion is composed of large cysts separated by septations. Review of sonograms and CT scans in nine patients shows that a large, predominantly cystic mass with internal septae is characteristic of the tumor. Angiography shows peripheral hypervascularity with a septated avascular center. A confident preoperative diagnosis of mesenchymal hamartoma based on these features is possible.

Pediatric percutaneous nephrostomy: experience with 50 patients.

Percutaneous nephrostomy tube placement was performed on 50 children with obstructed urinary tracts. The youngest patient was 3 days old and the smallest weighed 1,400 gm. The most common indication was obstruction after ureteral reimplantation (17 cases) followed by preoperative placement for pelvioureteral junction obstruction (15 cases). Infection was the most common presenting feature (14 cases), followed by a mass (11 cases) and renal failure (11 cases). Catheter placement was performed with basal sedation and general anesthesia was not used. There were no failures. In 26 patients no further surgery was required, including 16 of the 17 patients who had obstruction secondary to ureteral reimplantation. The only 2 significant complications were sepsis after catheter exchange in 1 patient and brisk hematuria upon placement of the catheter in another patient. Percutaneous nephrostomy tube placement is the method of choice for temporary relief of obstruction of the upper urinary tracts in children, since the hazards of surgery and general anesthesia are avoided.

Percutaneous drainage of hepatic abscesses in children.

Ultrasound guided percutaneous drainage of seven hepatic abscesses in five pediatric patients was performed. Abscesses were pyogenic in four of the patients and amebic in one. All patients recovered completely without surgical intervention. Methodology necessary in the pediatric patient is stressed.

Percutaneous aspiration and catheter drainage of abscesses.

Since 1980, we have treated 23 abscesses in 21 pediatric patients by percutaneous needle aspiration or catheter drainage or both. Percutaneous management has been completely successful in 16 of 21 patients and 18 of the 23 abscesses. In two patients, abscess drainage was technically successful and improved the patient's condition, but surgery was later required because of other complicating conditions. There were three failures of percutaneous aspiration or catheter drainage. Three serious complications occurred, but there was no mortality. Percutaneous management of abscesses is often a safe and effective procedure in pyogenic liver and postoperative abscesses.

Pediatric hypertension: an approach to imaging.

Since 1981, we have made diagnoses of secondary hypertension using state of art imaging equipment in 18 pediatric patients. The most valuable tests were ultrasound in identifying renal parenchymal disease, computed body tomography for adrenal tumors and intra-arterial renal angiography for renovascular disorders. Based on our experience, we have formulated an algorithm for the evaluation of the hypertensive pediatric patient. The initial step is careful clinical and laboratory screening to identify those patients that are likely to have essential hypertension and who should not undergo imaging tests. In the cases where there is a possible secondary etiology, renal ultrasound is usually performed first to identify parenchymal disease. If catecholamines are elevated, then abdominal computed tomography is the initial test. If no etiology is identified from these noninvasive studies, then direct intraarterial renal angiography is performed. The authors do not feel that excretory urography, radionuclide renography, intravenous digital subtraction angiography or selective renal vein sampling for renin are useful or practical screening tests for renovascular hypertension.

Sonography of adrenal glands in neonates and children: changes in appearance with age.

The sonographic appearance of the normal adrenal gland in children varies with age. In newborns, the cortex is large and hypoechoic, whereas the medulla is relatively small and hyperechoic. With increasing age, the cortex becomes smaller and the medulla relatively larger. The cortex remains hypoechoic and the medulla hyperechoic until age 5-6 months, by which time the gland has become hyperechoic and smaller, with poor or absent sonographic differentiation between cortex and medulla. After 1 year of age, the appearance of the gland is similar to that of the adult gland, with straight or concave borders and a hypoechoic character.